Surgical constructs and methods for securing tissue

ABSTRACT

Suture constructs and methods are provided for securing soft tissue to bone. One exemplary embodiment of a construct includes a first limb, a second limb, a coaxial region, and a collapsible snare defined by the first and second limbs. The coaxial region can be formed by a portion of the second limb being disposed in a volume of the first limb, which allows for a low profile construct that is useful in various soft tissue repair procedures. The construct can be configured to be disposed in tissue to draw the tissue toward bone, and the coaxial region can be deconstructed so that the first and second limbs can be used to help secure the desired location of the tissue with respect to the bone. Various features of the construct and methods for using the same in a surgical procedure are also provided.

CROSS REFERENCE TO RELATED APPLICATION

The present application is a continuation of and claims priority to U.S.patent application Ser. No. 16/363,421, filed Mar. 25, 2019, which is acontinuation of and claims priority to U.S. patent application Ser. No.15/001,513, filed Jan. 20, 2016, and now issued as U.S. Pat. No.10,258,321, which is a divisional of and claims priority to U.S. patentapplication Ser. No. 13/728,044, filed Dec. 27, 2012, and now issued asU.S. Pat. No. 9,271,716, the contents of each which is herebyincorporated by reference in their entireties.

FIELD

The present disclosure relates to surgical constructs and methods forsecuring soft tissue to bone, and more particularly relates to surgicalconstructs having reduced profiles for use in securing soft tissue whileminimizing or eliminating the tying of knots to tension and secure thetissue.

BACKGROUND

A common injury, especially among athletes and people of advancing age,is the complete or partial detachment of tendons, ligaments, or othersoft tissues from bone. Tissue detachment may occur during a fall, byoverexertion, or for a variety of other reasons. Surgical interventionis often needed, particularly when tissue is completely detached fromits associated bone. Currently available devices for tissue attachmentinclude screws, staples, suture anchors, and tacks. Currently availabledevices for patients of advancing age can be particularly insufficientdue to soft and weak bones leading to inadequate fixation between theanchor and bones and the anchors and filaments with which the anchorsare coupled.

Repair constructs made from one or more surgical filaments are typicallyused in soft tissue repair procedures to secure the tissue in a desiredlocation. The repair constructs are typically disposed through one ormore portions of the tissue to be repaired, which can cause trauma tothe tissue, and are often coupled to anchors disposed in bone to whichthe tissue is to be approximated. While devices and techniques have beendeveloped to help minimize trauma associated with passing repairconstructs through tissue, there is still room for further improvement.For example, some repair constructs typically include a sleeve disposedaround at least a portion of the limbs of filament of the construct. Thesleeve can assist in minimizing trauma to tissue, and also in managingthe limbs of suture while the construct is being disposed throughtissue. However, the sleeve still adds extra size and cost to theconstruct. Additionally, there remains a desire to minimize the numberof knots used in conjunction with the repair construct when performingsoft tissue repair procedures. A variety of different knots, such assliding knots, can be used to help draw and secure soft tissue withrespect to bone. Although the tying of knots at a surgical site iscommon, in some instances knots can have a tendency to slip, which inturn can cause a loss of tension between the tissue and bone. Thisdrawback is sometimes referred to as a loss of “loop security.” Inaddition to this “loop security” issue, conventional knots typicallyhave an overall size that can be obstructive or intrusive, especially intight joints, which may damage cartilage or other tissue by abrasionwith the knot.

It is therefore desirable to provide repair constructs and methods thatreduce the amount of trauma associated with using repair constructswhile maintaining or improving the holding strength such constructs andmethods can provide. It is also desirable to provide constructs andmethods for use in soft tissue repair that minimize or eliminate thenumber and size of knots to be tied by a surgeon, particularly duringarthroscopic repair procedures.

SUMMARY

Surgical constructs and methods are generally provided for securing softtissue to bone. In one exemplary embodiment the surgical constructincludes a first limb, a second limb that is shorter than the firstlimb, a coaxial region, and a collapsible snare defined by the firstlimb and the second limb. The coaxial region can be formed by a terminalend of the second limb being disposed within a volume of the first limb,with the snare being located on one side of the coaxial region and aterminal end of the first limb being disposed on the other side of thecoaxial region. The first and second limbs can be from the same surgicalfilament. In other embodiments the first and second limbs can be fromseparate surgical filaments. The surgical filament(s) can include, forexample, braided suture. The collapsible snare can include a slidableknot that adjusts a size of an opening defined by the snare by movingtowards and away from the coaxial region. In one embodiment, the size ofthe opening defined by the snare decreases when the slidable knot movesaway from the coaxial region and increases when the slidable knot movestowards the coaxial region.

The first limb of the construct can be cannulated at the coaxial region.A length of the coaxial region can be substantially shorter than alength of the first limb extending from the other side of the coaxialregion. The length of the coaxial region can also be substantiallyshorter than lengths of the first and second limbs on the side of thecoaxial region on which the snare is located. The coaxial region can beconfigured to be deconstructed after placement of the suture constructat a surgical location. This can allow the first and second limbs to beused to secure a location of the suture construct, for instance aftertissue coupled to the suture construct has been advanced to a desirablelocation proximate to bone.

The suture construct can also include a suture anchor having a filamentengagement feature. A portion of the construct can be slidably disposedaround a portion of the filament engagement feature. In some embodimentsthe snare can extend from one side of the anchor and the coaxial regioncan extend from another side of the anchor. In some other embodimentsthe portion of the first limb that is disposed on the other side of thecoaxial region can engage the filament engagement feature of the anchorsuch that this portion of the first limb extends from both sides of theanchor.

One exemplary embodiment of a surgical repair method includes selectinga surgical repair construct having a snare defined by a first filamentlimb and a second filament limb, and a coaxial region formed by aterminal end of the second filament limb being disposed within a volumeof the first filament limb. The method can further include fixing ananchor in bone in proximity to detached soft tissue. Further, a terminalend of the first filament limb can be passed through a portion of thedetached soft tissue and around an engagement feature of the anchor. Theresulting configuration can be one in which the snare extends from oneside of the anchor and the terminal end of the first filament limbextends from another side of the anchor. Still further, the method caninclude passing the terminal end of the first filament limb through thesnare, collapsing the snare to engage the soft tissue, advancing thecollapsed snare distally to bring the tissue into proximity with thebone, and removing the terminal end of the second filament limb from thevolume of the first filament limb to eliminate the coaxial region. Thefirst and second filament limbs can then be used to tie one or moreknots proximate to the collapsed snare to maintain the tissue at adesired location in proximity to the bone. The passing, collapsing, andadvancing steps, however, can be effected without tying a knot in thefirst or second filament limbs.

In some embodiments at least one of a first end of the surgical repairconstruct and a second end of a surgical repair construct can be passedthrough a surgical cannula. Further, in some embodiments the method caninclude passing the terminal end of the first filament limb through asecond portion of the detached soft tissue. The step of collapsing thesnare can include collapsing the snare around the first filament limbextending from the coaxial region and disposed on an opposite side ofthe coaxial region from the snare. Alternatively, in some embodimentsthe step of passing the terminal end of the first filament limb throughthe snare can include passing the coaxial region through the snare andthen collapsing the snare can include collapsing the snare around thefirst filament limb and the second filament limb disposed therethrough.

The anchor that is fixed in bone can include a suture shuttle filamentslidably coupled to the engagement feature. The suture shuttle filamentcan have a free end and a receiving end and can be coupled to the anchorprior to the step of passing a terminal end of the first filament limbthrough a portion of the detached soft tissue. In such embodiments, thestep of passing a terminal end of the first filament limb through aportion of the detached soft tissue and around an engagement feature ofthe anchor can rely on the suture shuttle filament to assist in movingthe surgical repair construct. More particularly, the terminal end ofthe first filament can be coupled to the receiving end of the sutureshuttle filament and a force can be applied to the free end of thesuture shuttle filament to move the receiving end of the suture shuttlefilament, and thus the terminal end of the first filament limb, towardand then around the engagement feature of the anchor. The suture shuttlefilament can then pass around and out of contact with the engagementfeature of the anchor, thereby allowing the surgical repair construct tobe in direct contact with the engagement feature. Eventually, theresulting configuration is the same as described above, with the snareextending from one side of the anchor and the coaxial region extendingfrom another side of the anchor. In some embodiments the suture shuttlefilament can be disposed through the detached soft tissue in twolocations. As a result, the surgical repair construct can also bedisposed through the detached soft tissue in two locations following thestep of applying a force to the free end of the suture shuttle filament.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1A is a schematic view of one exemplary embodiment of a surgicalrepair construct;

FIG. 1B is a detail view of a coaxial region of the surgical repairconstruct of FIG. 1A;

FIG. 1C is a schematic view of the surgical repair construct of FIG. 1Aillustrating one non-limiting example of potential lengths of portionsof the construct;

FIG. 2 is a schematic view of the surgical repair construct of FIG. 1Acoupled to a suture anchor;

FIG. 3 is schematic view of a suture shuttle filament coupled to thesuture anchor of FIG. 2; and

FIGS. 4A-4I are sequential views of one exemplary embodiment for usingthe surgical repair construct of FIG. 1A to secure tissue to bone.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the constructs and methods disclosed herein. Oneor more examples of these embodiments are illustrated in theaccompanying drawings. Those skilled in the art will understand that theconstructs and methods specifically described herein and illustrated inthe accompanying drawings are non-limiting exemplary embodiments andthat the scope of the present invention is defined solely by the claims.The features illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention. Additionally, to the extent that linearor circular dimensions are used in the description of the disclosedconstructs and methods, such dimensions are not intended to limit thetypes of shapes that can be used in conjunction with such constructs andmethods. A person skilled in the art will recognize that an equivalentto such linear and circular dimensions can easily be determined for anygeometric shape. Sizes and shapes of the constructs, and the componentsthereof, can depend at least on the anatomy of the subject in which theconstructs will be used, the size and shape of components with which theconstructs will be used, and the methods and procedures in which theconstructs will be used.

The figures provided herein are not necessarily to scale. Further, tothe extent arrows are used to describe a direction a component can betensioned or pulled, these arrows are illustrative and in no way limitthe direction the respective component can be tensioned or pulled. Aperson skilled in the art will recognize other ways and directions forcreating the desired tension or movement. Likewise, while in someembodiments movement of one component is described with respect toanother, a person skilled in the art will recognize that other movementsare possible. By way of non-limiting example, in embodiments in which asliding knot is used to help define a snare, a person skilled in the artwill recognize that different knot configurations can change whethermoving the knot in one direction will cause a size of an opening definedby the snare will increase or decrease. Additionally, a number of termsmay be used throughout the disclosure interchangeably but will beunderstood by a person skilled in the art. By way of non-limitingexample, the terms “suture” and “filament” may be used interchangeably.

Surgical repair constructs and methods for soft tissue repair aregenerally provided and they generally involve the use of surgicalfilaments that are configured in a variety of manners to minimize and/oreliminate the tying of knots during a surgical procedure. The constructsdescribed herein provide superior strength for use in a number ofdifferent surgical procedures, such as rotator cuff and instabilityrepair procedures and other types of tendon and tissue repairprocedures. The designs of the constructs described herein are such thatthey have a particularly low profile, thereby allowing a construct topass through the tissue with minimal trauma to the tissue and to becomeassociated with the tissue without tying knots. The low profile resultsfrom inserting one limb of filament into another and eliminating anysort of sleeve, which is often used to assist in shuttling limbs offilament through tissue. Further, the designs of the constructs are suchthat they limit the number of filaments that are used to feed theconstruct through the tissue, or otherwise associate the construct withtissue. As described, a single limb of filament can be used to associatethe construct with tissue that is being attached to bone, therebyassisting a surgeon with suture management.

As shown by one exemplary embodiment of a surgical repair construct 10in FIG. 1A, the constructs of the present disclosure are generallyformed from a single elongate filament that is folded to form a firstlimb 12 and a second limb 14. The first limb 12 can generally be longerthan the second limb 14, and the two limbs can be used to form both asnare 20 and a coaxial region 30 as described in greater detail below.The snare 20, which is disposed on a first end 10 a of the construct 10,can be configured to receive an opposite end 10 b of the construct 10and is operable to collapse around a portion of the construct disposedin an opening 22 thereof. The coaxial region 30 is generally configuredto allow the shorter second limb 14 to be disposed within a volume ofthe first limb 12, thereby eliminating any additional component forsuture management, such as a sleeve. The first limb 12 can then extendbeyond the coaxial region 30 to form a tail 40 of the construct 10. Thetail 40 can assist a surgeon with inserting the construct 10 to adesired location for a surgical procedure.

The collapsible snare 20 can be formed using any number of techniquesknown to those skilled in the art. In the illustrated embodiment thefirst and second limbs 12, 14 are formed to include a sliding knot 24.The sliding knot 24 is configured such that as it moves toward thecoaxial region 30, a size of the opening 22 defined by the snare 20increases, and as the knot 24 moves away from the coaxial region 30, thesize of the opening 22 decreases. Some exemplary knot types include aBuntline Hitch, a Tennessee Slider, a Duncan Loop, and a Hangman'sNoose. A person skilled in the art will understand that in otherconfigurations, a size of the opening defined by the snare may beadjusted in different manners, depending on the type of knot, desireduse, etc. Some exemplary snare and formations thereof are described inU.S. Pat. No. 9,345,468, entitled “Surgical Filament Snare Assemblies,”and U.S. Pat. No. 9,060,763, entitled “Systems, Devices, and Methods forSecuring Tissue,” the contents of which are incorporated by reference intheir entireties.

Further, in some embodiments a snare-retaining member (not shown) can bedisposed across the first and second limbs 12, 14, between the snare 20and the coaxial region 30, for instance to prevent the unintentionalcollapse of the opening 22 of the snare 20, such as while the construct10 is being moved through tissue. A snare-retaining member can include aflexible member or pin, such as the flexible members and pins describedin U.S. Pat. No. 9,060,764, entitled “Systems, Devices, and Methods forSecuring Tissue,” the content of which is incorporated by reference inits entirety.

The coaxial region 30 in the illustrated embodiment is formed by passingterminal end 14 t of the second limb 14 into a volume of the first limb12. As shown in FIG. 1B, at least a portion of the first limb 12 can becannulated, and an opening 16 on a side of the first limb 12 allows thesecond limb 14 to be disposed in the first limb 12. The opening 16 canbe created manually by forming a hole in the side of the first limb 12and removing a core of the first limb 12 so that there is space toreceive the second limb 14. Alternatively, the filament of the firstlimb 12 can be a braided suture with a core removed from at least theportion of the first limb 12 that is part of the coaxial region 30,thereby allowing the first limb 12 to receive the second limb 14. Inother embodiments a core of a filament, braided or otherwise, is notremoved and the second limb 14 is still disposed in first limb 12 usingtechniques known to those skilled in the art. The junction 18 at whichthe second limb 14 engages the first limb 12 can be a self-maintainingjunction. As a result, pulling on the tail 40 of the surgical construct10 does not cause the second limb 14 to pull out of the first limb 12.Rather, pulling on the tail 40 can actually force the first limb 12 tocollapse around the second limb 14, thereby providing sufficientfriction between the two limbs 12 and 14 to hold them together. The twolimbs 12 and 14, however, can be separated manually at the junction 18by applying a sufficient amount of force. Although in the illustratedembodiment the junction 18 is formed by inserting the terminal end 14 tof the second limb 14 into a portion of the first limb 12, a personskilled in the art will understand other ways by which the junction canbe formed without departing from the spirit of the present disclosure.

The tail 40 of the construct 10 is formed by the remaining portion ofthe first limb 12 that extends beyond the coaxial region 30. The tail 40can be used to help lead insertion of the construct 10 in tissue,coupling the construct 10 to a suture anchor, and leading the second end10 b of the construct 10 into the opening 22 of the snare 20 duringtissue repair procedures, among other things. Accordingly, a length andthickness of the tail 40 can be such that it ensures robust shuttling ofthe construct 10 during a surgical procedure.

The filament used to form the first and second limbs 12 and 14 can beany type and material typically used as filaments, including acannulated filament, a braided filament, and a mono filament. The typeand strength of the filament can depend, at least in part, on the othermaterials of the construct, if any, such as an anchor, the tissue andother components through which it will be passed or coupled to, and thetype of procedure in which it is used. In one exemplary embodiment thefilament is a #0 filament (about 26 gauge to about 27 gauge), such as anOrthocord™ filament that is commercially available from DePuy Mitek,Inc., DePuy Mitek Inc., 325 Paramount Drive, Raynham, Mass. 02767, or anEthibond™ filament that is commercially available from Ethicon, Inc.,Route 22 West, Somerville, N.J. 08876. A portion of the core of thefilament can be removed to form a cannulated portion of the first limb12 for use in the coaxial region 30. The thickness of the filamentshould provide strength in the connection but at the same time minimizethe trauma caused to tissue through which it passes. In some embodimentsthe filament can have a size between about a #5 filament (about 20 gaugeto about 21 gauge) and about a #3-0 filament (about 29 gauge to about 32gauge). Orthocord™ suture is approximately fifty-five to sixty-fivepercent PDS™ polydioxanone, which is bioabsorbable, and the remainingthirty-five to forty-five percent ultra high molecular weightpolyethylene, while Ethibond™ suture is primarily high strengthpolyester. The amount and type of bioabsorbable material, if any,utilized in the filaments of the present disclosure is primarily amatter of surgeon preference for the particular surgical procedure to beperformed. Additionally, although in the illustrated embodiment a singlefilament is used to form the first and second limbs 12 and 14, aseparate filament can be used for each of the first and second limbs 12and 14 without departing from the spirit of the disclosures providedherein.

The lengths of the various portions of the construct 10 can likewisedepend, at least in part, on the other materials of the construct, ifany, the tissue and other components through which it will be passed orcoupled to, the lengths of the various portions of the construct, andthe type of procedure in which the construct is used. The variousportions include the portions of the first and second limbs 12 and 14 onthe side of the coaxial region 30 the snare 20 is located, the coaxialregion 30, and the tail 40. In the illustrated embodiment the coaxialregion 30 is substantially shorter than both the tail 40 and theportions of the first and second limbs 12 and 14 on the side of thecoaxial region 30 the snare 20 is located. FIG. 1C provides oneschematic representation of a possible proportional length schemecomparing a length L₁ of a region between the knot 24 and one end 30 aof the coaxial region 30, a length L₂ of the coaxial region 30, and alength L₃ from the other end 30 b of the coaxial region 30 to a terminalend 12 t of the first limb 12. As shown the length L₁ can be about 17inches, the length L₂ can be about 2 inches, and the length L₃ can beabout 14 inches. A person skilled in the art will recognize that theselengths can change during the course of a procedure. For example, as thesliding knot 24 is selectively moved toward or away from the coaxialregion 30, the length L₁ will change. Likewise, a surgeon may be able tomanually adjust the lengths L₂ and L₃. Further, the lengths provided inthe illustrated embodiment of FIG. 1C in no way limit values of thelengths L₁, L₂, and L₃. Generally, the length L₁ can be approximately inthe range of about 5 inches to about 30 inches, the length L₂ can beapproximately in the range of about 0.5 inches to about 8 inches, andthe length L₃ can be approximately in the range of about 6 inches toabout 40 inches.

As shown in FIG. 2, the construct 10 can be coupled to a suture anchor50. The suture anchor 50 can include one or more filament engagementfeatures, such as the filament engagement feature 52 disposed at adistal end 50 d of the anchor 50. In the illustrated embodiment, thesnare 20 extends from one side of the anchor and the coaxial region 30extends from the other side of the anchor. However, in other embodimentsthe tail 40 can be engaged with the filament engagement feature 52 ofthe anchor 50 such that the tail 40 extends from both sides of theanchor, for instance as illustrated in FIG. 4D and described furtherbelow. Such a configuration can allow the portion of the first andsecond limbs 12 and 14 extending between the knot 24 and the coaxialregion 30 to not be within joint space, thereby assisting with suturemanagement by minimizing the number of limbs emanating from the anchor50.

As described in greater detail below, in some embodiments the construct10 can be pre-loaded on the suture anchor 50 prior to insertion of theanchor 50 to a surgical location, while in other embodiments theconstruct 10 is loaded onto the suture anchor 50 after the anchor ispositioned at the surgical location. One skilled in the art willappreciate that a variety of suture anchor types can be used inconjunction with the constructs provided herein. For example, in someembodiments the anchor can be a Gryphon™ anchor that is commerciallyavailable from DePuy Mitek, Inc. The constructs described herein can besingle-loaded or double-loaded onto a Gryphon™ anchor.

As a result of the configurations of the construct 10 described herein,anchors used in conjunction with the construct 10 can be smaller thanprevious anchors used in tissue repairs at least because a smallerdiameter or thickness of construct can be associated with the anchor.Further, Gryphon™ anchors are merely non-limiting examples of anchortypes that can be used in conjunction with the disclosures providedherein. Other types of hard and soft anchors can also be used. Someexamples of such anchors include a Healix Ti™ anchor, which iscommercially available from DePuy Mitek, Inc., as well as anchorsdescribed in U.S. Pat. No. 9,345,567, entitled “Systems, Devices, andMethods for Securing Tissue Using Snare Assemblies and Soft Anchors,”and U.S. Pat. No. 9,763,655, entitled “Systems, Devices, and Methods forSecuring Tissue Using Hard Anchors,” the contents of which areincorporated herein by reference in their entireties.

FIG. 3 illustrates one exemplary embodiment of a suture shuttle filament60 coupled to the suture anchor 50. Again, virtually any type of sutureanchor can be used in conjunction with the shuttles and constructsprovided herein, but the illustrated anchor 50 is a Healix™ anchor. Theshuttle 60 can be slidably engaged with the anchor 50 at the filamentengagement feature 52 such that a first end 60 a of the shuttle 60extends from one side of the anchor 50 and a second end 60 b of theshuttle 60 extends from the other side of the anchor 50. The first end60 a can be configured to be coupled to a repair construct, such as therepair construct 10 of FIG. 1A. As shown, the first end 60 a includes afixed loop 62, but any other suitable coupling mechanism can be used atthe first end 60 a without departing from the spirit of the presentdisclosure. For example, the first end 60 a can include a clip or a likeelement to clamp around a repair construct. In other embodiments theloop 62 can be a collapsible snare. Once the repair construct 10 iscoupled to the first end 60 a, the second end 60 b can be used toposition the repair construct 10 in a desired location as describedbelow with respect to FIGS. 4A-4D.

One exemplary embodiment of a method for performing a rotator cuffrepair using the repair construct 10 of FIG. 1A in conjunction with thesuture shuttle filament 60 of FIG. 3 is illustrated in FIGS. 4A-41. Asurgical opening can be formed through skin 100 and a cannula can bepassed therethrough to create a surgical repair site in a manner wellknown to those skilled in the art. Although cannulas are often used todefine a channel through which the procedure can be performed, thecannula is not shown in FIGS. 4A-4I for ease of illustration.Accordingly, to the extent the figures show components of the constructpassing through skin 100, these components would typically be extendingthrough the cannula, which itself is passed through the skin 100.Further, although the constructs and methods described herein areparticularly useful for minimally invasive surgery, such as arthroscopicsurgery, they can also be used in open surgical procedures.

As shown in FIG. 4A, the anchor 50 and suture shuttle filament 60illustrated in FIG. 3 can be fixated into bone 102 using ordinarytechniques, such as by using a driver to screw or tap the anchor 50 intoplace. In the illustrated embodiment the suture shuttle filament 60,which includes the first end 60 a having the loop 62 formed therein, isalready coupled thereto, although in other embodiments the sutureshuttle filament 60 can be slidingly coupled to the anchor 50 after theanchor 50 is positioned at its desired location.

As shown in FIG. 4B, the first and second ends 60 a, 60 b of the sutureshuttle filament 60 can be passed through detached soft tissue, such astendon 104. As shown in FIG. 4C, a portion of the tail 40 of the repairconstruct 10 of FIG. 1A can be passed through the loop 62, thereby, atleast temporarily, coupling the repair construct 10 to the shuttle 60. Aforce approximately in the direction A can then be applied to the secondend 60 b to pull the first end 60 a, and thus the repair construct 10,through the tendon 104 at a first location, around the filamentengagement feature 52, and through the tendon 104 at a second location.As a result, as shown in FIG. 4D, the tail 40 can be disposed around thefilament engagement feature 52 and, depending on the length of the tail40, can extend on both sides of the anchor 50. Once the suture shuttlefilament 60 has moved the construct 10 to a location that allows asurgeon to grasp the tail 40, either manually or by the use of asurgical tool, the suture shuttle filament 60 can be de-coupled from therepair construct 10. The tail 40 can then be used to continue to shuttlethe construct 10 to a desired location, for instance by applying a forcein a direction B. Alternatively, the shuttle 60 can continue to be usedto shuttle the construct 10 to a desired location for the construct 10before the shuttle 60 is de-coupled from the construct 10. Onenon-limiting , exemplary location for the construct 10 is shown in FIG.4E, in which the snare 20 is disposed on one side of the anchor 50 andthe coaxial region 30 is disposed on the other side of the anchor 50,with portions of the first and second limbs 12, 14 that are disposedbetween the snare 20 and the coaxial region 30 in sliding engagementwith the filament engagement feature 52.

As shown in FIG. 4F, the tail 40 and the coaxial region 30 can be passedthrough the snare 20 such that portions of the first and second limbs12, 14 that are disposed between the snare 20 and the coaxial region 30are disposed within the opening 22 of the snare 20, thereby allowing thetendon 104 through which the construct 10 is disposed to be captured.The snare 20 can then be collapsed or dressed around the portions of thefirst and second limbs 12, 14 disposed therethrough, with the snare 20remaining distal of the coaxial region 30. In embodiments in which asnare-retaining member is disposed through a portion of the construct 10to prevent the intentional collapse of the snare 20, the snare-retainingmember can be removed prior to collapsing the snare 20.

Alternatively, in other embodiments just the tail 40 can be passedthrough the snare such that only a portion of the first limb 12 isdisposed within the opening 22 of the snare 20, thereby allowing thetendon 104 through which the construct 10 is disposed to be captured.The snare 20 can then be collapsed or dressed around the portion of thetail 40 disposed therethrough. Although in such an embodiment thecoaxial region 30 is distal of the snare 20, the snare 20 can besubsequently slid distally toward the tendon to allow the coaxial region30 to become proximal of the snare 20, as described below with respectto FIG. 4G.

As shown in FIG. 4G, tension can be applied to the second end 10 b ofthe construct 10 by pulling approximately in a direction C, therebycausing the collapsed snare 20 to slide distally toward the tendon 104in a zip-line like manner until the snare 20 is adjacent to the tendon104. Alternatively, tension can be applied to the second end 10 b beforethe snare 20 is dressed and after the snare 20 is adjacent to the tendon104, or some combination of the two actions can be used, such aspartially dressing the snare 20 before zip-lining it toward the tendon104.

As shown in FIG. 4H, the coaxial region 30 can be disassembled such thatthe terminal end 14 t of the second limb 14 is no longer disposed in avolume of the first limb 12. The disassembly can occur at the junction18, for instance by untucking or pulling out the second limb 14 from thefirst limb 12. Alternatively, the coaxial region 30 can be removedentirely by cutting the limbs 12 and 14 at a location distal of thecoaxial region 30, thereby leaving a portion of the limbs 12 and 14. Ineither instance, the limbs 12 and 14 can then be cinched or otherwisetied together to assist in securing a location of the collapsed snare20, and thus the tendon 104 with respect to the bone, as illustrated inFIG. 4I. In the illustrated embodiment, a half-hitch 19 is formed by thesurgeon using the first and second limbs 12, 14. A second half-hitch canbe formed to lock the location of the first half-hitch 19.

Although in the illustrated embodiment the construct 10 is passedthrough two portions of tendon 104, alternatively the construct 10 canbe passed through only one portion of tendon or tissue while the secondportion of the construct 10 can be free of the tendon or tissue. Such anembodiment can be used, for example, during a labral repair. Either ofthe two ends 10 a, 10 b can be the end that is not passed through thetendon or tissue, although in some embodiments it may be useful to havethe end 10 a on which the snare 20 is located to not pass through tissueto minimize the possibility of unintentional collapse of the snare 20.Further, in some embodiments, rather than passing through tissue, arepair construct 10 can be coupled to tissue using other techniques,such as, for example, by wrapping the construct around the tissue.

Still further, although the method described with respect to FIGS. 4A-4Iuses the suture shuttle filament 60 to locate the construct 10 in adesired location with respect to the anchor 50, in other embodiments theconstruct 10 can be pre-coupled to the anchor 50 that is insertedthrough the cannula and to the surgical location. In such embodiments,exemplary methods can begin at FIG. 4D or 4E, with the construct 10already being coupled to the anchor 50 and the anchor 50 being fixatedinto bone 102 using ordinary techniques, such as by using a driver toscrew or tap the anchor 50 into place.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Further,although the constructs and methods provided for herein are generallydirected to surgical techniques, at least some of the constructs andmethods can be used in applications outside of the surgical field. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A suture construct, comprising: a first limbhaving a first length; a second limb having a second length that isshorter than the first length; a coaxial region formed by a terminal endof the second limb being disposed within a volume of the first limb; anda collapsible snare defined by the first limb and the second limb, thecollapsible snare being located on one side of the coaxial region and aterminal end of the first limb being disposed on the other side of thecoaxial region.
 2. The suture construct of claim 1, wherein thecollapsible snare includes a slidable knot such that a size of anopening defined by the snare is able to be decreased by moving theslidable knot away from coaxial region and the size of the opening isable to be increased by moving the slidable knot towards the coaxialregion.
 3. The suture construct of claim 1, wherein a length of thecoaxial region is substantially shorter than a length of the first limbextending from the other side of the coaxial region.
 4. The sutureconstruct of claim 3, wherein the length of the coaxial region issubstantially shorter than lengths of the first and second limbs on theside of the coaxial region on which the snare is located.
 5. The sutureconstruct of claim 1, wherein the coaxial region is configured to bedeconstructed after placement of the suture construct at a surgicallocation so the first and second limbs can be used to secure a locationof the suture construct.
 6. The suture construct of claim 1, furthercomprising a suture anchor having a filament engagement feature, aportion of the construct being slidably disposed around a portion of thefilament engagement feature.
 7. The suture construct of claim 6, whereinthe snare extends from one side of the anchor and the coaxial regionextends from another side of the anchor.
 8. The suture construct ofclaim 6, wherein the portion of the first limb disposed on the otherside of the coaxial region engages the filament engagement feature ofthe anchor such that the portion of the first limb disposed on the otherside of the coaxial region extends from both sides of the anchor.
 9. Thesuture construct of claim 1, wherein the first limb is cannulated at thecoaxial region.
 10. The suture construct of claim 1 wherein the firstlimb and the second limb are portions of one surgical filament.
 11. Thesuture construct of claim 10, wherein the surgical filament comprises abraided suture.
 12. A surgical repair method, comprising: selecting asurgical repair construct comprising: a collapsible snare defined by afirst filament limb and a second filament limb; and a coaxial regionformed by a terminal end of the second filament limb being disposedwithin a volume of the first filament limb; fixing an anchor in bone inproximity to detached soft tissue; passing a terminal end of the firstfilament limb through a portion of the detached soft tissue and aroundan engagement feature of the anchor such that the snare extends from oneside of the anchor and the terminal end of the first filament limbextends from another side of the anchor; passing the terminal end of thefirst filament limb through the snare; collapsing the snare to engagethe soft tissue; advancing the collapsed snare distally to bring thetissue into proximity with the bone; and removing the terminal end ofthe second filament limb from the volume of the first filament limb toeliminate the coaxial region.
 13. The method of claim 12, furthercomprising tying the first and second filament limbs into one or moreknots proximate to the collapsed snare after the coaxial region has beeneliminated to maintain the tissue at a desired location in proximity tothe bone.
 14. The method of claim 12, further comprising passing atleast one of a first end of the surgical repair construct and a secondend of a surgical repair construct through a surgical cannula.
 15. Themethod of claim 12, wherein the passing, collapsing, and advancing stepsare effected without tying a knot in the first or second filament limbs.16. The method of claim 12, further comprising passing the terminal endof the first filament limb through a second portion of the detached softtissue.
 17. The method of claim 12, wherein collapsing the snare furthercomprises collapsing the snare around the first filament limb extendingfrom the coaxial region and disposed on an opposite side of the coaxialregion from the snare.
 18. The method of claim 12, wherein passing theterminal end of the first filament limb through the snare furthercomprises passing the coaxial region through the snare, and whereincollapsing the snare further comprises collapsing the snare around thefirst filament limb and the second filament limb disposed therethrough.19. The method of claim 12, wherein the anchor in bone further comprisesa suture shuttle filament having a free end and a receiving end, thesuture shuttle filament being slidably coupled to the engagement featureof the anchor prior to the step of passing a terminal end of the firstfilament limb through a portion of the detached soft tissue, the step ofpassing a terminal end of the first filament limb through a portion ofthe detached soft tissue and around an engagement feature of the anchorfurther comprising: coupling the terminal end of the first filament limbto the receiving end of the suture shuttle filament; and applying aforce to the free end of the suture shuttle filament to move thereceiving end of the suture shuttle filament, and thus the terminal endof the first filament limb, toward and then around the engagementfeature of the anchor such that the suture shuttle filament passesaround and out of direct contact with the engagement feature of theanchor and the surgical repair construct is in direct contact with theengagement feature.
 20. The method of claim 19, wherein the sutureshuttle filament is disposed through the detached soft tissue in twolocations such that the surgical repair construct is also disposedthrough the detached soft tissue in two locations following the step ofapplying a force to the free end of the suture shuttle filament.